Survival following treatment with RMP-7 and carboplatin in malignant glioma who grade III–IV: Comparison with matched controls

Abstract INTRODUCTION Malignant glioma (MG) patients often experience chemotherapy-induced nausea and vomiting (CINV). Olanzapine has recently been added to national anti-emesis guidelines for patients on moderately/highly emetogenic chemotherapy. In this retrospective study, we investigated the use of olanzapine for refractory-CINV (R-CINV) in MG patients. METHODS In this chart review, we queried adult MG patients with KPS ≥ 70 who received olanzapine from January 2019-March 2020. Patients were included if they were prescribed olanzapine for CINV. Data on nausea/vomiting improvement, olanzapine dosing/schedule, number of refractory anti-emetic trials, concomitant corticosteroid use, and demographics were collected. RESULTS We identified 21 MG patients who were prescribed olanzapine, with 9 of those patients receiving olanzapine specifically for CINV. Seven patients had WHO grade IV glioma, and 2 patients had anaplastic astrocytoma (WHO grade III). Five of 9 patients (55.6%) were male, all were Caucasian and median age was 54 years. Patients tried an average of 3 anti-emetics prior to initiating olanzapine for R-CINV. Only one patient was taking concomitant corticosteroids; which is not in concordance with national anti-emesis guidelines. Four of 9 patients (44.4%) achieved control of R-CINV with olanzapine. The olanzapine dose and key biomarkers (IDH-status, MGMT promoter methylation) were similar between those experiencing R-CINV and those without symptoms. CONCLUSIONS In this study, we find that approximately half of patients with R-CINV achieved improved nausea and vomiting control with the addition of olanzapine. The lack of corticosteroid use for anti-emesis in MG continues to make this population challenging to manage. The relatively high success rate in patients that had failed, on average, 3 anti-emetics, suggests that olanzapine may be a potent addition to the anti-emetic toolkit for MG patients. These results inspire further large-scale research to validate this observation and define the optimal role for olanzapine in treating R-CINV in MG patients.

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ACTR-41. A PHASE II, SINGLE ARM STUDY OF OPTUNE® IN BEVACIZUMAB-NAIVE SUBJECTS WITH RECURRENT WHO GRADE III MALIGNANT GLIOMA

Neuro-Oncology ◽

10.1093/neuonc/now212.039 ◽

2016 ◽

Vol 18 (suppl_6) ◽

pp. vi11-vi11

Author(s):

Daniel O’Connell ◽

Jose Carrillo ◽

Xiao-Tang Kong ◽

Beverly Fu ◽

Daniela Bota

Keyword(s):

Malignant Glioma ◽

Phase Ii ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

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COT-01 SYMPTOMATIC EPILEPSY INDUCED BY MALIGNANT BRAIN TUMOR

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.184 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii40-ii41

Author(s):

Hirofumi Oyama

Keyword(s):

Brain Tumor ◽

Germ Cell ◽

Malignant Glioma ◽

Cell Tumor ◽

Malignant Brain Tumor ◽

Initial Symptom ◽

Who Grade ◽

Symptomatic Epilepsy ◽

Who Grade Iii ◽

Grade Iii

Abstract CASES We report about 41 cases of malignant brain tumor which were treated with operation, irradiation, chemotherapy during past 62 months. 34 cases of glioblastoma, 2 cases of malignant glioma(WHO grade III), 2 cases of medulloblastoma, 1 case of germ cell tumor, 1 case of malignant neurocytoma, and 1 case of malignant ependymoma were included in 41 cases. Two cases of glioblastoma survived over than 25 years, but the median survival of dead 11 glioblastoma cases was 22 months. 4 cases were expired among another 7 cases. RESULTS 6 cases showed mutation in ATRX and one case had mutation of IDH-1 among 34 cases of glioblastoma. One case showed mutation in ATRX and IDH-1 among 2 cases of malignant glioma. But the mutation in ATRX and IDH-1 had no correlation with convulsion. The initial symptom was epilepsy in 3 cases of glioblastoma and another 3 cases of glioblastoma showed convulsive seizure thereafter. One case of glioblastoma showed rapid aggravation of symptom after convulsion. The initial symptom was epilepsy in 1 case of malignant glioma. One case of malignant ependymoma and one case of medulloblastoma showed rapid aggravation of symptom after convulsion. DISCUSSION Nine cases showed convulsion among our 41 cases. Convulsion happened as initial symptom in 4 cases but it happened during treatment in 5 cases. Three cases among these 5 cases showed rapid aggravation of symptom after convulsion. So pre- and post-operative anti-epileptic treatment seems to be necessary.

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Outcomes After Proton Therapy Reirradiation for Malignant Glioma: Prospective Analysis of Over 100 Patients from the Proton Collaborative Group

10.21203/rs.3.rs-499865/v1 ◽

2021 ◽

Author(s):

Robert H Press ◽

Shaakir Hasan ◽

J Isabelle Choi ◽

Arpit M Chhabra ◽

Lia M Halasz ◽

...

Keyword(s):

Malignant Glioma ◽

Proton Therapy ◽

Proportional Hazards ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Collaborative Group ◽

Time Interval ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

Abstract Purpose: The optimal salvage treatment for malignant glioma after prior radiotherapy (RT) is not well established. Proton therapy (PT) is an attractive treatment modality for reirradiation (ReRT) of recurrent disease; however, data are limited.Methods: The prospective, multi-institutional Proton Collaborative Group (PCG) registry was queried for patients with malignant glioma who previously received RT and underwent PT-ReRT between 7/2011-10/2018. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method and Cox proportional hazards regression analysis. Results: 109 consecutive patients were identified. Median follow-up was 11.2 months and median time interval (TI) from prior RT (median 59.3 Gy) to PT-ReRT (median 49.6 Gy) was 45.7 months. Primary histology was glioblastoma (n=62), oligodendroglioma (n=26), and astrocytoma (n=20). Median PFS and OS was 6.1 and 11.1 months, respectively. On UVA, improved PFS was associated with oligodendroglioma (HR 0.39) and astrocytoma (HR 0.55) histologies, WHO Grade III (HR 0.36), TI (HR 0.989), surgical resection (HR 0.39), and PT-ReRT dose ≥50 Gy (HR 0.59) (all p<0.03), while improved OS was associated with oligodendroglioma histology (HR 0.35), WHO grade III (HR 0.33), ECOG 0 (HR 0.47), TI (HR 0.985), and PT-ReRT dose ≥50 Gy (HR 0.58) (all p<0.04). Late Grade 3 toxicities occurred in 5.6% of patients with no attributable acute or late Grade 4-5 events.Conclusion: In the largest series of glioma PT-ReRT reported to date, retreatment appears well tolerated with acceptable outcomes and favorable toxicities compared to photon historical controls. Dose escalation achievable with PT may improve outcomes for well-selected patients.

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Radiotherapy with Concomitant Temozolomide in WHO Grade III Glial Tumors

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.06.712 ◽

2008 ◽

Vol 72 (1) ◽

pp. S235

Author(s):

F. Zorlu ◽

M. Gurkaynak ◽

U. Selek ◽

S. Ulger ◽

A. Turker ◽

...

Keyword(s):

Who Grade ◽

Glial Tumors ◽

Who Grade Iii ◽

Grade Iii

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High-grade glioma with anterior skull base erosion and intranasal extension: case report

Journal of Neurosurgery ◽

10.3171/2016.4.jns151724 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1484-1487 ◽

Cited By ~ 1

Author(s):

Matthew T. Stib ◽

Michael Johnson ◽

Alan Siu ◽

M. Isabel Almira-Suarez ◽

Zachary Litvack ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Radiation Treatment ◽

High Grade Glioma ◽

Brain Parenchyma ◽

Anterior Skull Base ◽

High Grade ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion. MR imaging findings revealed a large intracranial lesion with intranasal extension. Endoscopic nasal biopsy revealed pathology consistent with an infiltrating glioma. The patient subsequently underwent a combined transcranial/endonasal endoscopic approach for resection of this lesion. Pathological diagnosis revealed a WHO Grade III oligoastrocytoma. This report reviews the mechanisms of extradural glioma extension. To the authors' knowledge, it is the second report of a high-grade glioma exhibiting nasal extension without prior surgical or radiation treatment.

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The Expression of Progesterone Receptors in Meningiomas of Different Grades

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v8i2.357 ◽

2019 ◽

Vol 8 (2) ◽

pp. 65-69

Author(s):

Mohammad Tahir ◽

Tehreem Atif ◽

Summaya Sohail ◽

Arfa Nawazish ◽

Huma Mushtaq

Keyword(s):

Progesterone Receptor ◽

Treatment Options ◽

Progesterone Receptors ◽

Lower Grade ◽

Immunoperoxidase Method ◽

Nuclear Staining ◽

Who Grade ◽

Grade Ii ◽

Who Grade Iii ◽

Grade Iii

Background: Meningiomas are slow growing intracranial and intraspinal neoplasms with a tendency to recur locally. WHO grades them as I (benign), II (atypical) and III (anaplastic) in order of their increasing aggressiveness, based on histological parameters and brain parenchymal invasion. Progesterone receptors (PR) are more prevalent amongst the lower grade meningiomas. The objective of this study was to determine the immunohistochemical expression of progesterone receptors in meningiomas of different grades.Material and Methods: A total of 100 cases were selected over a period of 2.5 years. Three to five microns’ thick sections stained with Hematoxylin and Eosin were examined microscopically by a team of two Histopathologists and graded into grades I, II and III, according to 2016 WHO classification criteria. Another section of the original tumor was stained with progesterone receptor antibody using the conventional immunoperoxidase method. Stained slides were than examined by the same team of Histopathologists and declared positive (if nuclear staining was observed in more than 10% of tumor cells) or negative. Statistical analysis was done using SPSS version 21.Results: Out of a total of 100 cases of meningioma, there were 79 cases of benign/typical WHO grade I, 15 cases of atypical/ WHO grade II and 6 cases of anaplastic/ WHO grade III tumor. PR status was positive in 89.8 % (71/79) of grade I meningiomas and 46.6 % (7/15) of grade II/Atypical meningiomas. The 06 cases of Anaplastic/WHO grade III tumors were negative for PR. There was a higher prevalence of Progesterone receptors in female patients (89.8%; 53/59) as compared to male meningioma patients (60.9%; 25/41).Conclusion: We observed a decreased expression of progesterone receptor in higher grades of meningioma in this study. It is an effort to explore conservative treatment options for inoperable lesions, as anti-progesterone therapy may hold a promise as a new treatment option in the near future.

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High-grade gliomas and molecular biology of neurosurgical oncology

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0007 ◽

2019 ◽

pp. 89-106

Author(s):

Stephen J Price ◽

Harry Bulstrode ◽

Richard Mair

Keyword(s):

Molecular Markers ◽

Who Classification ◽

High Grade Glioma ◽

High Grade ◽

Optimal Management ◽

Who Grade ◽

Normal Human ◽

Who Grade Iii ◽

Grade Iii

The term high-grade glioma (HGG) encompasses a number of histological entities that are considered by the WHO Classification as WHO Grade III and IV tumours. They have traditionally been considered as having similar behaviour and had been treated in a similar manner but recent advances in our understanding of tumour biology have led to the identification of molecular markers that are now central to the classification of these tumours. Normal human cells develop into cancer cells through a stepwise accumulation of genomic and epigenomic alterations and this chapter considers the molecular markers of gliomas and explains their significance before going on to discuss the optimal management.

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